The Politics of Sexuality and AIDS:
Psychosocial Aspects and OtherTheoretical Considerations

(Excerpts from Ray Noonan’s Chapters)

Raymond J. Noonan, Ph.D.

Synopsis: “When you have sex with someone, you’re having sex with everyone else they’ve had sex with,” is just one of the popular myths that are debunked by Dr. Noonan, making this his most important chapter—and the most controversial in the book. In it, he introduced his Sane Sex Alternative to contemporary misinformation about sex and AIDS, as well as his concept of AIDS-Related Fears and Anxieties (ARFA), a generalized, misdirected fear of sex and intimacy that plagues many people because of the misuse of AIDS and other potentially negative aspects of sexual expression as instruments of terror by those who wish to impose and enforce their own highly restrictive and narrow views of sexual morality. Included is a discussion of the concept of relative risk and how our perception of risk is distorted in sexual and other matters. A more accurate assessment of sexual risk is then presented. A must-read for everyone!

THE SANE SEX ALTERNATIVE

The “Sane Sex Alternative” is a comprehensive approach to sexuality education, conceived and developed by the author, that seeks to minimize the unwarranted fear of AIDS, the STDs—and sex—that is wittingly and unwittingly being created and fostered by some authorities.

To develop such a program involves balancing two weighty issues: how to give accurate messages about sex that promote its inherently safe nature as a healthy component of human experience, without losing sight of the fact that AIDS is certainly a serious health crisis from which people are suffering and dying—and from which one can protect oneself by honestly and directly confronting the real problems and adapting one’s behavior in appropriate ways. The fact that AIDS is firmly entrenched in minority populations should tell us more about the low value we as a society place on education, our attitudes toward disadvantaged classes, and the racism and drugs that still permeate our daily lives, than anything regarding how many sex partners one has or who they are. The fact that women—and minority women in particular—are becoming more at risk for contracting AIDS in the 1990s should tell us more about the sexism that still exists within dyadic interactions, as well as the issues of race, class, and education as stated above.

In this chapter, I describe a “Sane Sex” policy—one that stresses the positive, integrative nature of our cherished ability to explore and enjoy sexual expressiveness with ourselves and with other people. Based on honesty, this perspective calls for directly educating all people about the realities and responsibilities each of us has in expressing our sexual feelings, without resorting to scare tactics and misinformation. Some sexologists and sex educators, especially sensitive to past accusations of promoting sexually transmitted diseases (STDs), teen pregnancy, pornography, and “promiscuity,” (among other things) sometimes seem afraid to defend sexuality, because the sex-negative climate, both within and outside their professions, offers the same conclusion: Promoting sex as a healthy activity will promote AIDS. Unfortunately, that attitude persists today.

The “Sane Sex Alternative” calls for explicit sexual information (developmentally appropriate to the specific age group) on many topics: female and male relationships, male-male and female-female relationships, love and romance, AIDS, STDs and their prevention, masturbation and sexual abstinence, dating and marriage, having multiple sex partners, and basic sexual anatomy and physiology. It also includes truthful information about pregnancy, parenting, and birth control—contraception and abortion. “Sane Sex” teaches ethics, values, honesty, respect, and responsibility, as well as the traditional American values of tolerance, understanding, freedom of choice, and separation of church and state. “Sane Sex” is how one acts, without fear, based on an honest assessment of accurate information about one’s choices. The current reality of inadequate and partial education for living one’s sexual life must change. Complete, rational, and sex-positive messages must be given.

But how can we do that? Evaluating sexual behaviors as risks is an art as well as a science. What passes for cold hard fact many times is actually one individual’s or group’s moral precepts concealed in science. Sorting out the reality is difficult for experts; for the general public, conventional wisdom and prejudice often become the guide.

[The chapter then introduces] a discussion of the relative risks involved with various sexual behaviors during which HIV might be transmitted. . . . It proceeds from the premise that, for the most part and in most situations, sex is inherently safe. In fact, most sexual activity does not even result in pregnancy, let alone infection or death.

[Urquhart and Heilmann in their 1984 book, Risk Watch: The Odds of Life, try to] “correct the distorted perception that we are beset by risks of unprecedented magnitude, and to show that . . . the collective risks we face have fallen to a uniquely low value that is without historical precedent.” . . .

How [then] do we evaluate data from different risks, such as those sexual risks associated with HIV infection, and begin to make sense of them and use them for rational positive living? One way is to compare them to everyday risks that most of us accept at one level or another. I have been referring to this concept as relative risk, comparing one risk to another. . . .

Relative risk implies that different behaviors have differential risks that can be compared—in other words, how is one behavior more, or less, risky (read hazardous) than the other? What becomes important in this context is what this signifies for our perception of how we view each risk. Let’s look at two well known examples: Two of the most common “voluntary” risks many young and old people take for granted are those related to alcohol use and cigarette smoking. . . .

The number of deaths attributable to smoking [in 1991] is significantly higher than the total number of deaths attributable to alcohol (including drunk driving), accidents, AIDS, suicide, homicide, fires, cocaine, crack, heroin, and morphine combined. While any comparison of health risks that demonstrates the real relative risk of AIDS, versus other voluntary risks, leaves one open to the accusation that you are not taking the AIDS crisis seriously, the facts reveal how our perception of risk is more illusion than reality. Unfortunately, the illusions appear to be destined to follow us into the twenty-first century. Only by looking at problems in perspective are we able to avoid unwarranted fears and begin making rational decisions and choices.

Again, looking at real or relative risk is not meant to minimize the tragedy and suffering of AIDS and the opportunistic diseases that ultimately kill most—but not all—of those with HIV-induced immune suppression. Nor does it suggest that research or funding levels be reduced. It should, however, force us to look at our unrealistic and unsuccessful attempts at reducing other important voluntary risks, and help us put real sexual risks in perspective—hopefully allaying many unwarranted fears about sexual expression that are being fostered and promoting healthy decision making about sex.

The contradiction between the perceived risk of sexually transmitted HIV infection versus cigarette smoking can be shown by an example: A college dramatic group presented a series of skits on “safe sex” and condoms at a professional meeting of sexologists a few years ago that was designed to show us how one group of young people was taking sexual risk seriously, and how drama and humor were being used to promote this message to other students at their college; it was very entertaining and well received by the audience. At the end of the show, I happened to go into the hall as the rest of the meeting continued inside. The students obviously had enjoyed our reception and were sitting around talking about it. Almost every student was smoking a cigarette! While I’m sure they all knew of the dangers of smoking, no one apparently had told them about the relative risks—that cigarette smoking was far, far more life-threatening than most of the sexual behaviors they were eschewing for health reasons.

While some researchers and educators no longer talk about AIDS as belonging to one or another “risk group,” many others still do. The newest emphasis is: It’s not who you are, but what you do that matters; almost all of us can do almost anything, especially in terms of sexual behavior. This perspective, however, isn’t helped by the fact that most of us do categorize people by what they do and the fact that AIDS still tends to be concentrated in groups of people defined by certain behaviors, particularly those related to drug use. As such, it appears that drugs are now the key to the epidemic, and the primary route for the infiltration of HIV into the general heterosexual population. Without adequately addressing economic and class inequities in society, we can look forward to a continually escalating drug problem, and its resultant problems, particularly for minorities. Reiss [in his 1990 book, An End to Shame: Shaping Our Next Sexual Revolution] states:

Blacks and Hispanics make up only about 20 percent of our population, but they comprise over 46 percent of the 1989 AIDS cases. The heavy reliance on IV drugs in our impoverished neighborhoods is one of the major reasons for this high AIDS rate. In the area of heterosexually transmitted infection, blacks and Hispanics again predominate. They have accounted for 70 percent of the cases in heterosexual men and women and 75 percent of the cases of AIDS in children between 1981 and 1988 (pp. 126-127).

An example of how some authorities are propagandizing the public about sexuality—and how much of the media and some health professionals are compounding the problem—is the ever-widening so-called “window-of-opportunity” that continues to be emphasized. It is one thing to say that the AIDS virus can incubate for eleven years or longer, and another thing to assume that it is likely that this will usually be the case. In addition, though it is frequently emphasized that HIV is not transmitted casually, such as by touching someone who is HIV-infected or by touching something an infected person has touched, it is not usually stated that it is relatively difficult to transmit HIV through most sexual activities, unless some highly specific conditions are favorable to its transmission. (I explore this in detail later in this chapter.) But because it can happen that HIV is sexually transmitted in some circumstances, it has led to some insidiously powerful misconceptions and sex-negative conclusions.

Almost everyone has heard by now the presumed fact that whenever you sleep with someone, you are sleeping with everyone that person has slept with for the last ten or eleven years. It’s designed to get your attention, but it’s absolutely not true.

By having sex with someone, you are not having sex with every other partner your lover has had in the last ten or eleven years, contrary to that catchy slogan that continues to be promulgated. Using such a slogan implies to many a view of sexuality that denigrates all sexual experience, no matter how valid or valuable it is or has been. What is important, and what many intend by using this slogan, is that you know as much as you can about your partner’s history and possible risk behaviors over the last eleven years, so you can make an informed, rational choice about what precautions are appropriate for you. While I believe open communication is essential to any healthy relationship, I would suggest that the call for such personal-history taking is exaggerated, and that it is unlikely to be helpful as a means of ensuring that you won’t contract HIV. What is important is what you do with your present partner and the ordinary precautions you need to take to prevent both unintended pregnancies and unwanted infections.

Logically, if one accepts the premise and conclusion that sleeping with someone includes sleeping with everyone your partner has ever slept with, one could argue that by reading this book, you are reading the collected works of Western civilization, at least those by Americans in the last ten years. The notion is cute, but absurd. Equally absurd is the notion of one well known sex therapist, cited by Reiss [in his 1990 book, An End to Shame: Shaping Our Next Sexual Revolution], who extended the slogan to its illogical conclusion: When you have sex with someone, you are having group sex. Fumento [in his 1990 book, The Myth of Heterosexual AIDS] also raises some interesting points reminiscent of Susan Sontag’s (1978) Illness as Metaphor, when he discusses the metaphorical use of “group sex” to convert most people’s serial monogamist relationships over the past decade into the anathema of orgy. He cites medical historian Allan Brandt [in his article “AIDS and Metaphor,” published in the Autumn 1988 journal, Social Research], who insightfully elaborates on the metaphor:

At a moment when the dangers of promiscuous sex are being emphasized, it suggests every single sexual encounter is a promiscuous encounter. . . . As anonymous sex is being questioned, this metaphor suggests that no matter how well known a partner may be, the relationship is anonymous. Finally, the metaphor implies to heterosexuals that if they are having sex with their partner’s (heterosexual) partners, they are in fact engaging in homosexual acts. In this view, every sexual act becomes a homosexual encounter (p. 77).

HIV must enter one’s bloodstream before one can become infected. Current knowledge of transmission indicates that the virus attaches itself to cells in blood or semen, which one can receive through some specific, unprotected sexual activity or activities with a person who is infected with HIV, or through intravenous drug use. Absolutely vital seems to be the condition that there must be a break of some sort in the skin or mucous membranes to allow entry to the body; the virus (like other viruses, such as herpes) cannot break through intact skin. Probably because of this, many researchers believe that, contrary to IV-drug use in which one isolated exposure can transmit the virus since the injection purposely bypasses the natural protective barrier of the skin, repeated exposure to HIV as a result of unprotected sexual activities with an infected person is necessary to transmit the virus.

The issue of needle-sharing seems to have been ignored in other parts of the world as well [as in the U.S.]. Patton [in her 1990 book, Inventing AIDS] states, “The mediating factor of injection drug paraphernalia-sharing . . . was politely ignored (especially in African contexts) as was the continuing inability of some African countries to screen blood to Western standards, and to gauge the range of people infected with HIV” (p. 92), noting that, for example, malarial plasmodium, which is endemic in equatorial Africa, frequently gives a false positive HIV-antibody test result (p. 80). Other considerations about male-male sexual contact that is not recognized as homosexuality in the Western sense (Patton, 1990, pp. 89-91), and endemic parasitic and nutritional problems, have also not been adequately investigated as valid explanations for the spread of African AIDS. In non-recognition of these various facts, Patton notes, researchers instead theorized that ulcerative diseases were more prevalent in Africa, and posited that anal intercourse with prostitutes was the primary form of HIV transmission to heterosexual males, thus distorting our perception of the risk of the heterosexual transmission of HIV. She elaborates:

The attempt here on the part of researchers was clearly to reconcile cultural anxieties and stereotypes with certain curiosities in their own data. Their efforts were directed at explaining how in the West, and among whites, active homosexuals passed the virus to passive homosexuals, while in Africa and among prostitutes and people of color in the U.S., women engaging in anal intercourse passed the virus to heterosexual men. The collision of homophobia and racism provided the anus with a curious but pivotal gender: the female anus was thought capable of doing what the male anus was not (p. 91).

With the preceding discussion as a reference point, we can look at what might be called “high risk” sexual behaviors—or, more specifically, those that become so within an infected population. Unfortunately, much of the “safer sex” information aimed at heterosexuals in the United States today assumes that, in any given sexual context, one’s partner is HIV-infected—a “fact” that is generally false.

Anal intercourse (from men to women or men to men) is probably the most risky of all sexual activities for several reasons, including: the close proximity of capillaries to the inside surface of the rectum, the ease with which the lining of the rectum can be torn or otherwise injured, and the fact that HIV binds itself to semen; all three factors offer a direct line for the virus, or other unwelcome microorganisms, into the bloodstream. Though an important sexual activity in many male homosexual relationships, anal intercourse is thought by many to have been the primary means of HIV transmission to some women who have contracted AIDS during heterosexual activity. A well lubricated condom that also contains the spermicide Nonoxynol-9 will reduce the risk somewhat, and can reduce it greatly if used correctly and every time, for those who prefer this activity.

In most heterosexual situations, vaginal/penile intercourse is much less risky than anal intercourse, though probably more risky for women than for men, because infected semen can carry the virus into the uterus with its profuse abundance of blood vessels. Woman-to-man transmission appears to be more difficult than that from man to woman. It is less likely because of the usually high natural acidity (pH) of the vaginal fluids which tends to kill the fragile virus; however, there exists a wide range of pH balance in the healthy vagina. To minimize the possibility that the virus might be transmitted in either direction, a man could use a condom with the spermicide Nonoxynol-9 and a woman might use a spermicidal jelly or cream to provide the highest protection against both infection and pregnancy.

Alternatively, a couple might use a vaginal spermicide alone, though this is considered by many professionals to be ineffective. (With or without condoms, make sure any spermicide you use contains Nonoxynol-9; not all spermicides contain it, and it has been shown to be more effective in killing HIV than other chemicals; it is currently marketed in various strengths, from 1% to 5%, and is readily available in most drug stores.) Pregnancy is still far more compelling an issue than infection, and needs to be addressed honestly and directly in heterosexual couples, with each person taking an active role in sharing contraceptive responsibility.

I have argued that in couples where the man absolutely refuses to use a condom, the woman can take control of the situation and her own health by using a vaginal contraceptive alone—and for the “typical” heterosexual couple, this would be almost, if not equally, protective against HIV infection for the woman; my reasons for saying this is based on the information presented in this chapter, yet this idea remains controversial. Having vaginal spermicides available, like having condoms available, would also provide the woman with the ability to assume an important role in controlling her own body. Of course, if a man absolutely refuses to use a condom, the woman is also justified in saying no to any sexual contact, if she so chooses. It should be noted that no strategy (including those promoting monogamy and abstinence) is 100% effective in actual practice; while the effectiveness of the new alternatives I suggest here have not yet been sufficiently tested, the studies presented later indicate that there is reasonable evidence to support their inclusion with the “traditional” alternatives for couples. In addition, I believe they could play an important role where nothing else is available or acceptable. An important point to remember is that there is a choice: if both partners want to have intercourse, and for whatever reason one or both don’t want to use condoms, there is absolutely no reason for either of them to be left with no alternative—and no protection.

Oral sex is probably even less risky than the previously covered behaviors, though again, it is probably more risky for women than for their partners. Cunnilingus (stimulation of the vulva and clitoris with the mouth and tongue) is likely to be particularly safe (though less so during menstrual bleeding or if either person has open sores), while fellatio (stimulation of the penis with the mouth and tongue) can transmit the virus (again via the semen) to the man’s partner (male or female) through open sores in the mouth. Therefore, some experts urge those who practice fellatio to use a condom before any contact. If you do choose to practice fellatio without a condom, it is best not to allow ejaculation in the mouth; if you do, it is probably best not to swallow the semen, and perhaps, to rinse your mouth with mouthwash after doing it. Each activity adds an increased level of risk, and down the line you continue to have choices. While some experts counsel the use of a dental dam-type piece of rubber that is placed over the vulva and clitoris for cunnilingus, I believe it is usually not necessary, and stems from an exaggerated sense of its risk and a misunderstanding and unwarranted fear of the female sexual anatomy.

In summary, all of the sexual activities discussed above can allow the virus, which might be in infected blood or semen, to be spread through open sores or cuts and abrasions in the skin or mucous membranes of the penis, vagina, mouth, or rectum. Also, as I’ve noted earlier, it is currently believed that the number of contacts with an infected partner is relevant to the probability of infection. In other words, usually one sexual contact with an infected individual is not enough to transmit sufficient virus to cause immune suppression; repeated doses of the virus appears to be required to increase the chance of HIV infection.

In addition, while increasing the number of sexual partners, each of whom theoretically has an equal chance of being HIV-infected or not infected, will not increase your risk of HIV infection appreciably, if at all, what you do, in terms of what precautions you do or do not take, increases your chances of any kind of infection even more. Most health professionals believe that condoms, particularly with the spermicide Nonoxynol-9, provide the highest degree of protection against the transmission of HIV. I also advocate the use of a diaphragm (or cervical cap) with vaginal contraceptive jelly, or other spermicidal foams or creams containing Nonoxynol-9, with the diaphragm or alone, as alternative means of protection. This strategy remains controversial and has not yet been adequately considered and explored by researchers. North [in a 1990 article, “Effectiveness of Vaginal Contraceptives in Prevention of Sexually Transmitted Diseases,” published in Alexander, Gabelnick, & Spieler’s edited volume, Heterosexual Transmission of AIDS: Proceedings of the Second Contraceptive Research and Development (CONRAD) Program International Workshop, Held in Norfolk, Virginia, February 1-3, 1989 (pp. 273-290)], however, has described studies that have begun to investigate the effectiveness of these strategies in AIDS and STD prevention.

We know that, in the laboratory, agents containing Nonoxynol-9 kill or immobilize the virus that causes AIDS as well as some of the other STD microorganisms, including those that cause chlamydia, herpes, gonorrhea, syphilis, and trichomonas infections (North, 1990), and that they help to prevent gonorrhea and syphilis in everyday use. In fact, the diaphragm, when used correctly with contraceptive jelly, has been shown to be extremely effective in protecting against gonorrheal infection (North, 1990).

Two risk behaviors—both of which are actually being promoted by conservative religious and political authorities to eliminate HIV-transmission risk—that have received little attention as potentially doing just the opposite, are sexual abstinence and monogamy. Reiss [in his 1990 book, An End to Shame: Shaping Our Next Sexual Revolution], in particular, has been instrumental in pointing out the contradictions inherent in the strategy of making these the sole focus of any and every AIDS, STD, or pregnancy prevention program.

Reiss (1990) believes that “no one in our society seems to accurately estimate the risk factor in the abstinence strategy,” hence “abstinence is a much more dangerous path to pursue than condom usage,” because “a ‘strategy’ alone does not guarantee that people will abide by it” (p. 125, emphasis in original). He explains his reasons for this conclusion:

To evaluate the risk involved in pursuing abstinence, one cannot assume that everyone is a perfect adherent and always achieves abstinence in his or her behavior. We must calculate in our measure of risk the proportion of people who fail in the pursuit of abstinence. Otherwise, we’re not facing reality and not making a fair evaluation of the chances that the abstinence strategy will reduce HIV infection.

Consider this: What if we assumed that all condoms and all condom users were perfect? We would then erroneously view the use of condoms as without any risk. Nobody would accept this as a fair estimation. The proper way to judge condom effectiveness is to estimate the actual failure rate of condoms in everyday life. By the same token, the fair way to judge the strategy of pursuing abstinence is to estimate what proportion of people break their vows of abstinence and what risks of infection they then encounter. We can no more assume that every believer in abstinence invariably abstains from sex any more than we can assume that every condom user will have perfect condoms and be a perfect user.

When one makes an unbiased comparison of promoting abstinence vs. promoting condom use, the results are obvious. Vows of abstinence break far more easily than do condoms (p. 125, emphasis in original).

This becomes problematic for teens, and can potentially increase their risk of HIV and STD infection, as well as unintended pregnancy, in the case of failed abstinence, because they are then unprepared for sex when it does happen, as it naturally, almost inevitably does for most. Having noted elsewhere that American teenagers experience more of these problems than do teenagers anywhere in the Western world—while teenagers are having sex at about the same rate worldwide—Reiss points out that, before they are out of their teens, 80 percent of our teenagers will be sexually active, and voices his concern about unintentionally misguiding our youth:

Because of the emphasis on abstinence, many of these sexually active young people will not have been prepared to protect themselves from pregnancy, AIDS, or other sexually transmitted diseases. Promoting only abstinence can be dangerous for our children. . . . In a world like ours where the great majority are sexually active, the choice of parents is to deliberately prepare their children for safer sex in case they choose to have sex, or to try to impose abstinence on them, thereby allowing them to drift into sex unprepared to protect themselves and their partners (p. 126).

One of the most perplexing aspects of the current AIDS epidemic is the fear that is being generated by the disease, and which is being promoted by some people. I have coined the term AIDS-Related Fears and Anxieties (ARFA) to describe both the rational and irrational fear of sex and intimacy that has resulted from sensationalism and misinformation about AIDS propagated by certain segments of the media, political and religious leaders, and even some health professionals. Fear of AIDS itself is a subcategory of ARFA, and is, in fact, probably a minor part of it. Homophobia, the irrational fear and hatred expressed toward homosexual individuals that is both exploited and encouraged by many politicians and religious leaders, is a separate psychological disorder which can contribute to ARFA.

AIDS Phobia has been described by Jäger [in his 1988 book, AIDS Phobia: Disease Pattern and Possibilities of Treatment] as an “unfounded conviction of being infected, often in spite of repeated medical assurances to the contrary.” AIDS-phobic sufferers can experience feelings of acute anxiety and long-term depression, and can even sometimes develop symptoms mimicking actual AIDS conditions. While certainly relevant to our discussion here, I posit that AIDS Phobia is probably a minor part of ARFA, in that the incidence of the exaggerated fear of AIDS itself is subordinate to the more generalized fears related to sex and intimacy that I have suggested. The fuel for this anxiety is often guilt about one’s past sex life. The notion that “sex = death” is much less often involved, despite the fact that AIDS itself can equal death, given our current knowledge, which, at least partially, accounts for some of the rational fear
of AIDS.

ARFA, as stated earlier, is both the rational and irrational fear of sex and intimacy that has resulted from the sensationalism and misinformation about AIDS that has been propagated by certain segments of the media, political and religious leaders, and some health professionals. It, too, can be experienced in a number of ways, including acute anxiety and long-term depression. Sufferers may choose to be celibate, both from an unfounded fear of being contagious and/or of contracting contagion.

Sexual guilt is a primary component of ARFA, in the same way that it contributes to AIDS Phobia. Too many normative, perfectly healthy behaviors are considered bad and unacceptable because of the morally rigid indoctrination that many people have had throughout the lifecycle, and this needs to be changed. For example, we must recognize and accept premarital sexual relationships and experimentation as, for most, an inevitable and normally healthy way of growing up and maturing—and one that should be encouraged with adequate guidance and support. Most adolescents will—and should—(again using the precautions, such as condoms and spermicides, noted above) have multiple sexual partners—because it enhances psychosocial development, self-esteem, and social coping skills—before “settling down” to one or more semi-permanent marriages or relationships. It is important to note that all “relationships” are not necessarily meant to be long-term or “committed,” and that “casual” sex is, for the most part, nonexistent, a misnomer; it is the rare sexual encounter that is casual for most people, regardless of its duration or the level of commitment. Some people seem to focus on the “failures” of most relationships, yet fail to recognize that over-protectiveness and isolation can be just as destructive and painful. This is true for both young people and adults, and encourages irrational thinking and negativity toward all sexual relationships.

Here we see clearly the impact on sexuality that our Judeo-Christian heritage has had on both our public and private perceptions of sexuality. Because of St. Augustine, the most influential of all early Christian theoreticians, whose vilification of sexuality is felt to this day, sexual desire—and anything associated with it, was forever tainted and devoid of innocence. To him, sex was “the root of evil, the means by which sin is passed on from one generation to another” (Lawrence, 1989, p. 125). . . . When Augustine rejected his mistress of fourteen years in favor of a neurotic relationship with his mother, and promulgated sex in marriage as the lesser of two great evils, he “crowned Western theology with a negativity toward sex” (Lawrence, 1989, p. 2), the unfortunate effects from which we continue to suffer today.

Yet recent scholarship indicates that most of this sex-negativity, derived mostly from Augustine and his interpreters throughout history, is not rooted in earlier Judeo-Christian philosophies. In The Poisoning of Eros: Sexual Values in Conflict, Lawrence (1989) describes how, “On the one hand we have inherited a powerfully sex-affirming biblical tradition, and on the other hand a deep suspicion of sex, acquired mainly from the Greco-Roman tradition. The latter has achieved ascendancy in Christendom, but it has never fully succeeded in quashing the former” (p. 1). He notes, for example, that Biblical texts are commonly viewed “through the distorting prism of platonism” (p. 1), the Greco-Roman notion of body/mind dualism. Lawrence says:

For example, the biblical literature is read as if it endorses monogamy, which it does not. The story of Sodom is metamorphosed from a cautionary tale about inhospitality into one about sexual sins. Onan is similarly reworked, distorted into a concern about masturbation. The New Testament texts, however, are the most distorted. The presumption that Jesus and Paul were sexual celibates has no foundation in biblical material and in fact flies in the face of strong circumstantial evidence to the contrary. . . . The appearance of the word “fornication” in English translations of the New Testament provides the strongest distortion in favor of Greco-Roman sexual values. As a translation of the Greek porneia, “fornication” is perhaps the most deliberately mistranslated word in biblical literature, a literature that demonstrates no interest in the modern concern about “sex outside the bounds of marriage” (pp. 1-2).

In today’s repressive political climate when religious intolerance is being turned into public policy, it is important to realize that the roots of religion, seemingly so crucial to almost every society in some form, do not necessarily preclude rational thought or humane acceptance of humanity’s cultural and philosophical diversities—or the positive force of sexuality in human life. Especially in the United States, such concepts are historically rooted in our ideals, if not our practice. We need to reclaim these birthrights, particularly those related to our sexuality. The moralists must not be allowed to immorally use distorted visions of morality to corrupt our sexuality.

My own observations while an officer in the division devoted to AIDS program services in the New York City Department of Health, provide yet another example of how political considerations might have been used to promote a repressive moral stance in condemnation of a prevalent sexual behavior, this time with regard to prostitution. While serving there in late 1987/early 1988, the preliminary results of a study of female prostitutes and their HIV-transmission rates to their male clients indicated that the rate of transmission was “insignificant.” The results of the study were never released and the study was not continued at that time, arguably because it didn’t meet the “moral” requirements that some were seeking, i.e., that prostitution is evil and should be condemned. Since this study could not be used to justify the political suppression of prostitution, or to support the fear of the high infectivity rate of prostitutes to their clients, the information was suppressed, an example of the axiom that, while two wrongs don’t make a right, three wrongs do, when in the service of “morality.” In addition, the fact that prostitutes are probably at a much higher risk than their clients has rarely been seriously addressed and dealt with properly in any municipality or in the mass media. Instead, you see or hear televised “public disservice announcements” of how someone got AIDS from one contact with a prostitute—possible yet improbable. The issue here, outside of sex, is likely to be one of class. Prostitutes as an underclass do not deserve the rights and considerations that their (higher classed) clients deserve.

We do know that the history of AIDS is very much a part of the history of racism, classism, sexism, and other prejudices. We are caught between experts acknowledging that AIDS is rapidly invading the black and Hispanic communities via the intravenous drug route and politicians failing to provide money to eradicate the drug problem because of political considerations and a willingness to ignore its root causes.

Much of what we have been talking about here is commonly referred to as “safe sex” or “safer sex.” What this means is the evaluation of one’s own risk and the ability to rationally decide on the necessary precautions needed—and taking those precautions—to protect oneself. It may involve the avoidance of activities involving the exchange of bodily fluids (using the methods described above, such as condoms). It also refers to expanding one’s erotic repertoire to include activities such as kissing, massaging, touching, fantasizing, and that oxymoron, mutual masturbation. Many of these can contribute positively to the excitement of romance and can enhance a relationship.

Much of the allure of “safer sex” is this new emphasis on romance—and the activities, once mistakenly referred to as “foreplay,” that are now considered to be an integral part of eroticism, courtship, seduction, and lovemaking. Sexual communication, combined with verbal communication, continues to be an important way for two people to build a strong and intimate bond, whether on a short-term basis with several people, or on a long-term basis with one monogamous partner—or any variant in between, where most people’s behavior falls [as I discussed in my paper, Evolving Marriage: The New Sexualities in Perspective, delivered at the IV World Congress of Sexology in Mexico City, Mexico, December 17, 1979].

Nevertheless, by linguistically linking the variants of safe with sex, we may have served to indirectly and uncritically uphold the rhetoric that sex is dangerous. My emphasis here is that, for the most part and in most situations, sex is inherently safe (hence, the term “Sane Sex” is preferred). In 1986, I wrote and spoke about this concept at professional meetings of sexologists and elsewhere—the idea that the very terms “safe” or “safer sex” explicitly imply that sex, in itself, is dangerous—and it was very well received. Yet it’s taken until the 1990s for some professionals to independently reach the same conclusion, or to recognize its validity and themselves use the idea openly. It seems that the fear has been that admitting the fact that sex is intrinsically safe and healthy would itself promote AIDS. The fear is so strong, in fact, that many have yet to recognize the damage done by indiscriminately using the phrases “safe sex” or “safer sex” in an educational vacuum, i.e., outside of a “Sane Sex” (or similar) framework as described earlier.

[Similarly,] too often, sex and drugs are linguistically linked as if they were equated evils; unfortunately, far too many people actually do believe that both are equivalently evil or
unhealthy.

One of the chief complaints of many who oppose efforts to give honest sex information is that it promotes sexually “promiscuous” behavior. (Promiscuous behavior is rarely defined, but it is commonly noted by sex-positive experts that it usually means to the person using the term that of having more sexual partners than he or she has had—or at least publicly has acknowledged.) Nevertheless, most research has shown that those who have access to accurate sex information tend to act more responsibly [as Diane de Mauro & Debra Haffner demonstrated in their 1988 study, “Sexuality Education and the Schools: Issues and Answers,” for the Sexuality Information and Education Council of the United States (SIECUS) in New York]. When looking at HIV transmission, it is justifiable to look at the impact of having multiple sex partners, since that preference has been so heavily promoted as high-risk. A look at some of the myths, and the facts, is in order.

In actual practice, does reducing the number of one’s partners actually reduce the risk of contracting the AIDS virus? Arguably, under certain conditions (which don’t generally exist today), such as high levels of HIV infectivity and prevalence, reducing the number of partners seems to make sense. But under more realistic conditions, does it make as much sense as, for example, promoting the use of condoms?

[In “Evaluating Strategies to Avoid AIDS: Number of Partners vs. Use of Condoms,” published in the November 1989 issue of the Journal of Sex Research, pp. 411-433,] Reiss and Leik (1989) looked at exactly that issue and concluded that, between those two most widely publicized risk-reduction strategies—reducing the number of partners and the use of condoms—in both high and low prevalence groups, consistent and careful use of the condom was, by far, the most effective method of reducing the risk of HIV infection. They suggest that by focusing on reducing the number of partners, and neglecting the condom, some authorities are doing a disservice to young people. They say:

It is our conclusion [. . .] that urging people to limit the number of partners is a potentially futile strategy. In principle, careful selection of partners can offer some reduction of risk, but [. . .] that strategy depends upon factors that are difficult to assess and control. Of far greater importance is convincing people to use reasonable protection. Difficult as that may be, that is where our efforts will pay off in reduction of risk of HIV infection (Reiss & Leik, 1989, pp. 433-434).

What about the separate, but similar issue of monogamy? It might be said that monogamy is its own reward, like drugs, blind faith, and other promises unrealized. Yet monogamy continues to hold the allure of intimacy and commitment. Certainly, many couples can and do enjoy lifelong monogamy. For most individuals, however, monogamy is only palatable in small doses—hence, for most, monogamy is usually experienced in a form that social scientists call “serial monogamy.” Serial monogamy—while not strictly monogamy by definition—is a standard form of dating or courtship practiced today whereby the partners “go steady” with (or marry) a series of partners, one after the other, for varying periods of time and with varying periods of time between them. It is one way in which our culture has “bent the rules” in order to maintain the myths that monogamy is the ultimate form of sexual union and commitment to another. By redefining monogamy, society maintains monogamy on its undeserved and unnatural pedestal; the confusion fostered by this design serves to promote untold heartache and suffering for many people, both old and young.

It’s often been stated that heterosexual women are currently the most at risk for HIV infection, and I’ve supported that notion to some degree when I discussed the higher relative risk for women in my sexual risk assessment earlier, though it appears that the real overall risk remains relatively low. It should be noted that, with regard to AIDS, promoting monogamy versus condoms and/or spermicides as a significant risk-reduction strategy is even more tenuous than promoting abstinence. Reiss [in his 1990 book, An End to Shame: Shaping Our Next Sexual Revolution] states the facts very convincingly:

The typical HIV-infected woman is not promiscuous. She is in a monogamous relationship with a drug addict. Most of the male heterosexuals infected with HIV are intravenous drug users and most of the women who pick up the infection heterosexually are their regular sexual partners. A woman takes the highest possible risk of infection if she enters a monogamous relationship with an intravenous drug addict who may well not know he is infected. Staying with an IV drug user and not using condoms is the all too common means of heterosexual infection (pp. 121-122, emphasis in original).

The apparent paradox in this instance—that monogamy is more risky (in terms of HIV-transmission) for female heterosexuals than multiple sexual partners—clearly demonstrates that we are not getting accurate information out to people, and even when it is given, that we are timid in emphasizing the reality. Despite this paradox, it is remarkable how many people still cling to the notion that if they find a monogamous relationship, they will be protected from HIV, based on this fact alone.

Within marriage and analogous relationships, most couples (both hetero- and homosexual) will likely face the issue of sex outside the relationship. The widely practiced traditional extramarital affair, where one or both partners surreptitiously have sex with others, oftentimes leaves the participants with feelings of guilt and shame, whether or not the affair becomes known. While devastating to the individuals, the most destructive aspect of the affair for the relationship is the (mutual) mistrust that usually accompanies the revelation of their secret lives.

I’ve characterized this developing scenario [of widening our perspective on providing healthy sexual choices for diverse populations] as the Post-Modern Era of the Sexual Revolution, a period in which the Sexual Revolution has matured—with many of its gains taken for granted, yet with just as many temporarily shrouded in confusion and fear. This Post-Modern Era will undoubtedly include a time in which both individual and couple therapy will flourish, just to unravel and repair the damage caused by using AIDS to distort the healthy and natural expression of sexuality. It is important to state that the Sexual Revolution is still with us; the reports of its death have been greatly exaggerated. Perhaps these reports are wishful thinking on the part of those who want to return to those imagined times when men were men and women were women and everyone knew their place—culturally “Neanderthal” times—but most contemporary people would not accept the loss. Patterns are changing with the pendulum of time; yet people will continue to strive for its freedom.

Again the need for a comprehensive sexuality education program becomes apparent. If, as national education policy, we had taken sexual health seriously and had educated people about it and how to deal with issues surrounding STD prevention and multiple partners, we would not have underreacted to AIDS when it was first identified, nor would we be overreacting in other ways, much as we overreacted to herpes a decade earlier. If we start to deal honestly with sex as a natural, healthy fact of life, and prepare people to deal with its powers and potentialities, we will go a long way toward promoting a responsible, rational approach to sexuality. We would minimize the spread of HIV and we would enhance people’s relationships—and their ability to cope effectively with the everyday problems that everyone in a relationship has to face.

One of the most important areas in which we professionals must be totally frank is in promoting the use of condoms. If we honestly told couples that using condoms was, for now, the best way to protect oneself during sexual intercourse, we might go a long way toward providing a rational approach to sexuality education and decreasing the spread of HIV, as well as many STDs and unwanted pregnancies. If, for example, instead of saying that condoms were the best thing to come along since ice cream—or whatever else we consider indicative of utopia—we said, “It’s the best we have for the time being, and we need everyone to use them for a while, until we find a better alternative,” we might even nearly eliminate these problems.

If we tell a young man—or for that matter a young woman—that condoms will not interfere with sex or that they will not decrease sensitivity for the man, all they have to do is use one once, and they’ll know we’ve lied to them. And once they know we’ve lied to them, they will not trust whatever else we try to tell them; they will treat everything we say with suspicion. However, if we acknowledge their concerns from the beginning—they’ve already heard some of the facts and misconceptions from their friends—they will have confidence in our truthful, straightforward approach. When talking about condoms, one might instead say, “O.K., condoms may not be the best way to have sex, they can decrease your feelings during intercourse, and they can interfere with the spontaneity and enjoyment of having sex, but, a growing number of people are learning to integrate them in a positive way into their lovemaking and are finding that they don’t need to be intrusive. We have serious problems here—AIDS, STDs, unintended pregnancies—and we don’t know as much about how to stop them as we’d like, but we believe using condoms can protect you, and more importantly, your partners, and you should use them.” In this way, we would begin to get our message across. Moreover, it should be important for us to emphasize that it is ‘manly’ for men to protect their partners from the possibility of passing sexually transmitted diseases, as well as from the possibility of unintended pregnancies.

It should come as no surprise that many pro-sex people are pro-choice, though by no means all of us. Those with generally positive attitudes toward sexuality tend to have more tolerant attitudes toward human diversity and cherish those cultural differences. However, those with oppressive political agendas, including most anti-abortion-rights people, tend to have more narrow views about right and wrong, with cultural diversity having little or no intrinsic value—and in many cases engendering deep prejudices and fears. Nevertheless, because one’s moral views can be chosen (either because of one’s moral education or in spite of it), one can maintain an anti-choice position while holding a generally pro-sex philosophy.

In perhaps no other area is the lack of tolerance for human diversity more apparent—and more dangerous, given the publicity surrounding the AIDS crisis—than in AIDS education. Here, too, our First Amendment rights are abridged preventing the production and dissemination of vital life-saving information that could be effective in limiting the spread of HIV. Anke Ehrhardt [in her 1991 Preface to “John Money: A Tribute,” in the Journal of Psychology & Human Sexuality] wrote about a speech given by John Money that “reflected his despair about and passionate fight against the current antisexual mores in the US that are now taking on a new and tragic meaning—they determine how AIDS education and prevention are to be conducted.” She says:

In 1991, we are still almost completely paralyzed in our ability to produce and deliver AIDS education materials, including videotapes and television programs, that can adequately inform about sexual-risk behavior, eroticize condom use, and talk about alternative sexual practices which can protect against HIV infection. We are not allowed to use appropriate language, realistic images, or straightforward messages that inform children, adolescents, men, and women in the US. The Helms Amendment has powerfully banned federal money from being spent on education that portrays homosexuality in a respectful and sensitive manner, and most private funders have followed suit by staying away from such controversial projects and issues (Ehrhardt, 1991, p. xii).

It’s long been my contention that the “homo” part of “homosexuality” has exacerbated the animosity of American antisexualists only slightly, whereas it’s the “sexuality” part that really incites. “Hetero” only seems to mitigate it inconsequentially. Where does the opposition come from in censorship and pornography, AIDS and STDs, contraception and abortion, and other similar issues? The “sexuality” part.

While most of us are aware that we gained the right to choose abortion in 1973 with the Roe v. Wade decision by the Supreme Court (and came close to losing it with the Webster v. Reproductive Health Services decision in 1990), few people today realize that it was only in 1965 that married couples won the right to obtain and use contraception (Griswold v. Connecticut, 381 U.S. 479), and in 1972 that unmarried persons gained the right to obtain contraception (Eisenstadt v. Baird, 405 U.S. 438)—hard-won life-saving rights many young people take for granted in 1992.

If it’s a dangerous time for free people, Canadian composer Bruce Cockburn—whose lyrics in the 1984 song, “Lovers in a Dangerous Time” in the album Stealing Fire—sees clearly, in the unique way that artists continue to see things, that this is also a dangerous time for lovers. But love will survive. Unbridled art—that which does not serve corporate, economic, or repressive social purposes—in some ways, like sex, is itself at risk from those who wish to mold it to fit their own cosmology. Calls for censorship are on the rise, as are assaults on basic freedoms. In fact, the threat seen by Cockburn can be interpreted as the threat by those who wish to deny sexuality; the lovers are at risk of losing love. In a sex-negative society, this is a much more realistic way to conceptualize “safe sex,” which is often inadvertently used more as an admonition against love and sexuality than its affirmation.

I have attempted to point out some of the incongruities in our collective logic and the resultant incorporation of ignorance, prejudice, and fear into our legal and social codes—and the present and potential damage they can inflict on our sexual health and psychology. The range of topics shows vividly how far-reaching and deep today’s prevalent underlying antisexual attitudes are. Yet I have also tried to guide us in seeking solutions. In almost all of the scenarios I have presented, I have sought to expose the roots of our positive sexual heritage that lie hidden just beneath the negative—and how we can begin to implement the positive effectively through education and determined action.

Over two decades ago, a futuristic sexologist predicted that all sexually transmitted diseases would be eradicated in our lifetime; instead there are new diseases, with the old ones still as active as before. He had a belief that we had the technology to, in fact, achieve this, as well as to make contraception most effective and abortion unnecessary. I believe that we still have this capability—if we care to use it. If we begin to approach sexuality education forthrightly, we will go a long way to achieving our goals.

I am convinced that the “plague” of AIDS will not be around forever, nor will it kill off entire generations, as some people have indicated. If it does, it will be the first in history to do so. The last great epidemic, some say the last epidemic ever, was the 1908 influenza epidemic that destroyed 250,000 (mostly young) people in the United States in two years. Like that and other historic epidemics, every plague has had its own natural history: it begins, it devastates some number of people, and it recedes into history in varying degrees. There is no reason to assume that this disease will be any different from every other disease that went before it.

Some people will turn out to have natural immunity to the virus, for whatever reason we can’t now fathom. Many others will likely die. The essential difference between those historic plagues and AIDS is that AIDS is linked to sexual transmission. Because of that link, it carries with it an enormous load of emotional baggage wrought by contemporary society’s paradoxical and irrational attitudes toward sexuality. If we are honest with ourselves and with our children, we will tell them—as we have learned to tell them about fire, electricity, nuclear energy, and other powerful natural forces—how to effectively confront and control the negative potentialities that undoubtedly exist, along with the fact that sexuality is essentially natural, safe, and healthy—and meant to be enjoyed by everyone.

If you enjoyed these excerpts from Dr. Noonan’s chapter, you’ll find his updated and expanded version even more enlightening. Click here for more information, orClick here to buy it!Now out of print, but available soon in Adobe Acrobat (PDF) format! However, used copies might be available.

The latest on positive sexuality from the first book to address the issue: For anyone concerned about the increasingly negative ways in which sex is being portrayed in public life—and who wants to do something positive about it.

Now out of print, but available soon in Adobe Acrobat (PDF) format! However, used copies might be available at amazon.com.

Check Out These Recent Books of Note with Contributions by Dr. Ray Noonan

Volume 4 of the International Encyclopedia of Sexuality (IES4), including 17 new countries and places, Robert T. Francoeur, Ph.D., Editor, and Raymond J. Noonan, Ph.D., Associate Editor, published in May 2001 by Continuum International Publishing Group: Includes my chapter on “Outer Space,” which highlights cross-cultural sexuality issues that will have an impact on the human future in space, based partly on my dissertation. For the table of contents or more information, see the IES4 Web site: http://www.SexQuest.com/IES4/, including supplemental chapters available only on the Web. Order from amazon.com!

“The Impact of AIDS on Our Perception of Sexuality” and “Sex Surrogates: The Continuing Controversy,” in Robert T. Francoeur’s Sexuality in America: Understanding Our Sexual Values and Behavior, published in August 1998 by Continuum Publishing Co. This new book contains an updated version of the chapter on the United States contained in the International Encyclopedia of Sexuality, Vol. 3 (in the set below). Now available in paperback at amazon.com!

Two articles in Robert T. Francoeur’s International Encyclopedia of Sexuality, published in August 1997 by Continuum Publishing Co.: “The Impact of AIDS on Our Perception of Sexuality” and “Sex Surrogates: The Continuing Controversy” in the United States chapter in volume 3, and additional comments (with Sandra Almeida) in the chapter on Brazil in volume 1. Encourage your library to purchase this three-volume, 1737-page set—the most comprehensive cross-cultural survey of sexuality in 33 countries ever published. Order from amazon.com.

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